Adolescent Patient Requiring Frenectomy - Laser technology has allowed clinicians to improve the level of dental care they provide to their patients. The soft tissue laser can be used in daily practice for precise soft tissue applications, providing rapid healing of the patient and increasing revenu...

Recontouring of Gingival Height via the Soft Tissue Laser - Critical to a natural, esthetic smile is a harmonious soft tissue architecture. The evolution of advanced technology offers every clinician the opportunity to significantly improve the health, design, and overall appearance of the soft tiss...

Flap sutures for guided tissue regeneration - The flaps are coronally repositioned and sutured to complete coverage. Use a non-resorbable or slowly resorbing suture since it must maintain its function for 2-4 weeks. A modified mattress suture is recommended to facilitate coronal repositioning of and...

Figure 2 - Clinical examination of the patient revealed the compromised aesthetic appearance of the maxillary right central and lateral incisors. Severe gingival and incisal misalignment were also evident.

Figure 3 - Although orthodontic therapy could have been used to correct this situation, this modality was declined by the patient, who selected treatment with an implant-supported restoration and was subsequently prepared for a simultaneous bone and soft tissue augmentation.

Figure 4 - The right central incisor was extracted as atraumatically as possible following flap elevation, the alveolus was cleansed, and an implant was immediately placed in the site of tooth #8(11) while respecting 3-dimensional considerations for proper orientation (ie, buccolingual, mesiodistal, apicocoronal)

Figure 5 - A buccal fenestration of 6mm and a vertical discrepancy between the bone crest and the implant of 3 mm were observed. This vertical deficiency between the implant and bone had to be resolved using a bone graft and membrane in order to avoid the resorption of the vestibular bone junction, which could have compromised the appearance of the definitive restoration.

Figure 6 - Due to its improved vascularization and remodeling capabilities, fresh autogenous bone was harvested from the retromolar region with a 6mm trephine bur to promote osteogenesis at the site of extraction.

Figure 9 - A connective tissue graft was also performed to prepare the soft tissue for the initial prosthetic treatment. Following the placement of the graft, the periosteal flap was released, positioned in a coronal fashion, and closed with mattress sutures.

Figure 10 - A postoperative antibiotic regimen that included analgesics and 0.12% chlorhexidine was prescribed to prevent infection and maintain proper hygiene during the healing period. Fifteen days postsurgery, the sutures were removed, and a bonded provisional crown restoration was placed.

Figure 13 - Once the membrane had been removed, it was possible to assess the horizontal bone growth along the vestibular bone junction as well as the vertical bone growth in the mesial and distal aspects.

Figure 14 - As a result of the regeneration process, bone papilla had been formed. This newly regenerated osseous contour would serve as the underlying support for the soft tissue in the subsequent restorative phase.

Figure 19 - At 15-day intervals, the provisional restorations were removedto permit additional contouring. The successive addition of acrylic material to the restorations was used to facilitate the formation of the interdental papillae and proper contour of the concave gingival architecture through blanching of the soft tissues.

Figure 21 - Once minor tissue molding had been performed, a set of polyvinylsiloxane impressions were taken and forwarded to the laboratory to permit the fabrication of models and the definitive ceramic full-coverage crown restoration.

Figure 22 - Porcelain material was applied to a ceramic abutment that corresponded to the actual intraoral environment in order to fabricate a restoration that would achieve the biomechanical and aesthetic objectives that had been established preoperatively.

Figure 23 - The definitive porcelain crown restoration was returned to the clinician and connected to the implant with an occlusal set screw to permit evaluation of contact points, occlusion, and contour.

Figure 25 - The optical characteristics (eg, color, luster, translucency) of the restorations achieved the aesthetic requisites of the patient. These results demonstrate that when the supporting hard and soft tissues are properly reconstructed, implant therapy is an effective means of single-tooth replacement.

Aesthetic Considerations for Surgical Crown Lengthening - Recent patient interest in aesthetic treatment has resulted in the development of advanced surgical and restorative procedures that are capable of conservatively addressing such objectives. While numerous materials and techniques have been de...

Figure 3 - The deficiency of tissue around the implant was treated with a particulated autograft, resorbable membrane, and a connective tissue graft. Note the increase in vertical and horizontal contour.

Figure 4 - The flap was released at the base, replaced over the surgical site, and secured with mattress and interrupted sutures. Care was exercised to prevent papillae damage by suturing with microsutures.

Figure 6 - At abutment connection surgery, a palatal flap was elevated to permit access to the implant and to harvest connective tissue. Note the short buccal incisions and the use of a buccal pouch procedure.

Figure 2 - Preoperative view of tooth #10. Previous endodontic treatment included placement of a post and crown. Note marginal gingival inflammation and recession, along with discoloration of the root.

Figure 5 - The internal (nonporous) aspect of an e-PTFE barrier membrane was placed over the bone graft material. The membrane was positioned between the soft tissues and bone graft material and was secured with a cross mattress suture.

Figure 6 - Six months postextraction of tooth #7, the barrier membrane was removed. At this time, the soft tissues had migrated under the membrane and over the bone graft to completely close the wound.

Figure 15 - At the time of the second-stage surgery, complete implant coverage is noted following removal of membrane from delayed implant placement site. Complete hard tissue coverage over the previously exposed implant threads is evident.

Figure 4 - A small mixture of autologous bone, resorbable hydroxyapatite, and PRGF was placed in the sinus region following implant placement. A bioabsorbable membrane steeped in PRGF was used to cover the exposed region.

Figure 8 - A biopsy obtained from the lower layer of the maxillary region demonstrated the presence of well-ordered trabeculae. Osteocytes and some components of chronic inflammatory tissue (infiltrate) were also observed.

Figure 9 - The biopsy obtained from the flap elevation site indicated the presence of grafted bone separated from the base of the sinus, which is a more osteogenic bed. The trabeculae were poorly organized and indicated the development of "immature spongy bone".

Figure 3 - Moderate calculus accumulations were located on the mandibular incisors, and pocket depths in the maxillary anterior region ranged from 7 mm to 10 mm at the palatal aspects of the central incisors.

Figure 5 - Following the hygenic phase of treatment, periodontal surgery was initiated at the maxillary anterior region. Intrasulcular incisions on the labial and palatal aspects were performed between teeth #6(13) and #11(23).

Figure 6 - Wide full-thickness flaps were elevated to improve visualizations and access to the circumferential defects present around teeth #8(11) and #9(21). Care was taken to preserve the interdental papillae. Calculus deposits were located in the deeper apical regions of the roots.

Figure 9 - Interdental vertical mattress sutures were utilized to ensure primary healing between the flaps and to achieve interdental papillae that were devoid of craters. To improve adaptation of the large palatal flap to the bone and roots, long mattress and "figure-eight" sutures were used.

Figure 10 - While healing was uneventful, an unavoidable minor recession of the gingiva and the interdental papillae was noted. Pocket depths were reduced to 1 mm to 2 mm. Patient motivation and compliance remained excellent throughout the surgical and immediate postoperative phases.

Figure 8 - 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the second root and canal; neither was evident on preoperative radiographs.

Connective Tissue Allograft Used to Manage Generalized Gingival Recession - The treatment of gingival recession through the creation of a "tunnel" beneath the buccal mucosa allows coronal repositioning of the soft tissue with predictable root coverage and aesthetics. Vertical incisions on either sid...

Treatment of Gingival Recession with a Modified "Tunnel" Technique and an Acellular Dermal Connective Tissue Allograft - A 39 year old nonsmoking male patient presented with a noncontributory medical history and mild to moderate gingival recession on teeth #11(23) through #13(25) Contributed by...